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LGA briefing: Health and Social Care Bill White Paper

This briefing summarises only the proposals of most relevance and significance to local government. It also provides the LGA’s initial reaction to the proposals along with our policy messages, which may necessarily evolve as discussions on the proposals continue.

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Introduction

Please note that this briefing was amended on 18 February 2021.

On 11 February, the Department of Health and Social Care (DHSC) published the legislative proposals for a Health and Care Bill. The proposals in the white paper are a combination of:

  • Proposals developed by NHS England (NHSE) to support the implementation of the NHS Long Term Plan (and which are the main focus of the document). 
  • Additional proposals that relate to public health, social care, and quality and safety matters, which require primary legislation 

The White Paper emphasises that the legislative proposals should be seen in the context of broader current and planned reforms to the NHS, social care, public health and mental health. It commits to bringing forward detailed proposals for reform on these key policy areas later this year.

This briefing summarises only the proposals of most relevance and significance to local government. It also provides the LGA’s initial reaction to the proposals along with our policy messages, which may necessarily evolve as discussions on the proposals continue. It does not summarise or comment on proposals that are primarily focused on the NHS.

Summary of key LGA messages

  • The White Paper provides a promising base on which to build a more collaborative culture. It sets out a clear direction of travel for enabling NHS organisations to work more effectively together, and for the NHS to work as an equal partner with local government.  The critical role of local government to the health and wellbeing of our communities has been a fundamental LGA lobbying and influencing message.
  • We are therefore pleased that the Government has acted on local government’s call for collaboration to achieve two linked but distinct objectives: integration within the NHS to join up care and support; and equal partnership between the NHS, local government and other partners to both address the wider determinants of health and deliver better and more coordinated health and care services for people.
  • We will continue to work with Government to ensure there is clarity regarding the respective roles and responsibilities of the proposed ICS NHS Statutory Bodies and the ICS Health and Care Partnerships, including how they: relate to health and wellbeing boards and integrated activity at local level; and support local leaders in developing arrangements that work best for local areas. Any future accountability mechanisms will need to build on and enhance existing local democratic accountability, not bypass or undermine it. It is imperative that local government remains directly accountable to our residents.
  • We welcome the renewed focus on the importance of the local government footprint, particularly:
    • Recognition that this is the place at which real change happens
    • The commitment that existing local partnerships and democratic structures should be based on local government place
    • The expectation that integrated care systems (ICSs) will delegate functions to place-level partnerships.
  • We are keen to work with NHSE and DHSC to ensure that the principle of subsidiarity is put into practice and hard-wired into the way ICSs, NHSE, councils and DHSC work with places, building from the bottom up.
  • Since the transfer of public health to councils in 2013, local government has proved that public health is more effective and appropriate to local health challenges when it is locally led. Locally led public health teams have played a vital role in responding to the pandemic. Furthermore, local public health leaders have a crucial role to play in ensuring that local strategies for health and wellbeing have the promotion of health, wellbeing, independence and resilience at the core. We are concerned about the proposal to create a power for the Secretary of State for Health and Social Care to require NHSE to discharge public health functions will undermine local leadership of prevention and promoting wellbeing. We will seek clear assurance from Government that this will not adversely impact on local government’s public health responsibilities.
  • We note that many of the proposals about improvements in data flow relate to those between health and social care, and there is an absence of reference to local authorities’ public health role. We would like to see a commitment to share data with Directors of Public Health and local public health teams as standard practice, to allow them to fulfil their statutory duties. Throughout the COVID-19 pandemic, local government has repeatedly had to make the case for Directors of Public Health to receive data about residents in their areas, and this should not be an afterthought.
  • Adult social care has continually demonstrated its value as an essential local public service in its own right over the last year and it is helpful that the white paper acknowledges the pressures facing social care and the need to address its long-term sustainability and reform. However, such acknowledgement only goes so far and it is disappointing that the Government’s immediate priority for social care is to strengthen national oversight of care and support, rather than bring forward its long-awaited wider funding reforms to support people of all ages to live the life they want to lead.
  • The Government needs to publish a clear timetable for its wider reform agenda at the earliest opportunity to give reassurance to all those people who draw on and work in social care that there will be no further delays.
  • With regard to national oversight of adult social care, we recognise the need for more transparency. We will work with government to ensure that any  national arrangements  build on existing best practice, are focused on the care and health system as a whole, and are genuinely co-designed with people with lived experience.

Summary of proposals of most relevance to local government

This section highlights the proposals that have most relevance to local government and gives the LGA’s views of them.

The White Paper sets out the case for a new legislative framework to facilitate greater collaboration within the NHS and between the NHS, local government and other partners, and to support the recovery from the pandemic. The primary aim of the NHS is to improve health and wellbeing outcomes, reduce health inequalities, improve services and make best use of limited resources, recognising the increasingly complex needs of many of our population. 

Many of these proposals were set out in the NHS’s recommendations to Government to help deliver the aims of the NHS Long Term Plan and have already been the subject of an NHSE consultation. These proposals recognise that the whole health and care system, including local government, has a vital role in addressing the health and wellbeing challenges of our populations. The white paper gives an undertaking that the legislation will support and enable existing NHS and local government partners to build on their partnership arrangements to join up care and support and address the wider determinants of health.

In addition, there are new proposals of relevance to local government on social care and public health. The document reiterates that the reform of social care remains a manifesto commitment and though proposals are not included, they will be brought forward later this year. It also includes a commitment to publish proposals on the design of the public health system

Working together and supporting integration

The legislative proposals seek to facilitate integration within the NHS, between different NHS organisations, and between the NHS and local government (and wider partners) to improve the health and wellbeing of local people.

There is a commitment that the legislation will create a flexible, ‘enabling framework for local partners to build on existing partnerships at place and system levels or, if this hasn’t yet happened, to kickstart this process’. The key factors are: a shared purpose within places and systems; the recognition of diversity and variation of forms and the balance of responsibilities between places and the systems that they are part of; and the realities of the different accountabilities for local government and the NHS. The legislation will enable places and systems to agree their own arrangements that suit their particular circumstances and characteristics.

Integrated Care Systems (ICSs)

In England, Integrated Care Systems (ICSs) will be established as statutory bodies. The ICS NHS Body will be responsible for the day to day running of the ICS, while the ICS Health and Care Partnership will develop a plan to address the system’s health, public health and social care needs. Public and ‘patient voice’ will be important in both bodies. The dual structure recognises that there are two forms of integration that will be enshrined in legislation: integration within the NHS to enable NHS organisations to work together across a system; and integration between the NHS, local authorities and other partners to deliver improved outcomes for health and wellbeing of their populations.

The ICS will be required to establish an ICS Health and Care Partnership, bringing together wider partners across the NHS, social care, public health and wider stakeholders.

The document acknowledges that the creation of two distinct parts of an ICS adds complexity and will require each system to have clear governance and accountability for both parts. There is also recognition that the NHS and local government have different accountabilities. Local government being accountable outwards to local people, and holding local NHS organisations to account through their overview and scrutiny powers and duties.  NHS organisations are primarily accountable upwards to the Secretary of State for Health and Social Care through NHSEI. The legislation will recognise and preserve these distinct accountabilities.

LGA view

We support the creation of a statutory NHS Body to integrate health services in a system and welcome the intention to establish health and Care Partnerships to ensure there is a partnership of equals that can set out plans for improving population health and delivering better and more integrated care and health services The document says that the ICS will set up the partnership and local areas can ‘appoint members and delegate functions as they see fit’. It is not clear whether this is intended to mean that the ICS NHS Body will set up the ICS Health and Care Partnership. Our strong view is that the establishment of the partnership in each system must be a joint responsibility of the NHS body and local councils. We support local flexibility and we are keen to support health and local government leaders to work as equal partners in setting up the ICS Health and Care Partnership.  There is a risk that if this is the sole responsibility of the ICS NHS Body, in areas with no track record of collaborative partnerships between the NHS and local government, this will perpetuate the NHS dominance of the ICS Health and Care Partnership. We have many examples of existing effective partnerships and are keen to work with DHSC and NHSE to promote these as examples of good practice.



We welcome the recognition that each ICS will need to agree how the ICS NHS Body and the ICS Health and Care Partnership work together and be held to account through the different accountability mechanisms for local government and the NHS. It will be important for any new national accountability mechanism to build on and enhance existing local democratic accountability, not than bypass or undermine it.

ICS NHS Body

Putting ICS NHS Bodies on a statutory footing will give them decision-making powers and responsibilities for NHS system performance, delivery and sustainability. It will also allow NHS England to have an explicit power to set a financial allocation or other financial objectives at a system level.

The ICS NHS Body will be responsible for the day to day running of the ICS and have specific requirements to develop a plan to meet the health needs of the population within their area, to set the strategic direction of the system and develop a capital plan for NHS providers in their system. The ICSs will be required to meet the system financial objectives which require financial balance to be delivered.  However, it will not have the power to direct providers, and providers’ relationships with the Care Quality Commission will remain unchanged.

It will also take on the commissioning functions of CCGs within its boundaries and some of those of NHS England. It will be able to delegate commissioning and functions to place level partnerships and provider collaboratives.

With regard to membership and governance, the Board of the ICS NHS Body will have a unitary board directly accountable for NHS spend and performance, comprising as a minimum a chair, the ICS chief executive, representatives from NHS trusts, general practice, and local authorities. The Board will need to ensure that it has appropriate clinical advice. The chief executive will be the accounting officer for NHS money allocated to the NHS ICS body.

The name of the ICS NHS Body will reflect its geographical location, for example NHS Nottinghamshire or NHS North West London. NHSE will be publishing guidance on the Board of NHS ICS Body, including how chairs and representatives should be appointed.

The NHS ICS Body will take on CCG responsibilities in relation to local authority overview and scrutiny committees.

LGA view

We support putting ICS NHS bodies on a statutory footing as one way of promoting greater collaboration between NHS organisations and enabling them to focus on shared, system-wide objectives for improving health outcomes, improving care and support and making best use of resources.

ICS Health and Care Partnership

The ICS Health and Care Partnerships' key role will be to develop a plan to address the health, social care and public health needs in its system, to which each ICS NHS Body and local authority will be required to have regard. Membership of the ICS Health and Care Partnership could include representatives of HWBs, local Healthwatch organisations, the voluntary and community sector, social care providers, housing providers and other partners involved in health and wellbeing.

The DHSC identifies that there is potential for the ICS Health and Care Partnership to be a forum for greater coordination and alignment of funding on key issues, and gives a commitment to working with NHSE and the LGA to develop guidance and support in establishing ICS Health and Care Partnerships.

LGA view

We are pleased that the DHSC has heard and acted on local government’s calls for a wider health and care partnership to promote collaboration and equal partnership beyond the NHS. We strongly welcome the commitment to ensure flexibility for systems to develop their own Heath and Care Partnerships that are built on existing partnerships and which reflect and are appropriate to a system’s unique combination of experience, assets and challenges. Health and Care Partnerships will need to give serious consideration to how they can best serve people in their area and will need to be mindful of what is and could be best delivered at place level and how to build on this.



Many such partnerships are already firmly embedded and making strong progress.  We can learn from these areas to promote good practice elsewhere. The LGA is committed to working with DHSC and NHSE to develop a coordinated implementation support offer to help these partnerships to reach their full potential.

Duty to collaborate

There will be a duty to collaborate across the NHS and local government.  This will replace two existing duties to cooperate.  Additionally, NHS bodies will have a duty to achieve the triple aims of the Long Term Plan: better health and wellbeing, better quality healthcare and ensuring the financial sustainability of the NHS.

LGA view

The LGA have long called for a shared duty of collaboration so we are pleased to see this proposal. We are keen to work with DHSC and NHSE to draw on existing collaborative planning and delivery to encourage and support all areas to escalate the scale and pace of collaboration.

The role of place

The white paper underlines the importance of ‘place’ as where joining up of care and support is most effective.  Place, in most cases, will be the defined by the local authority ‘place’. ICSs will be most effective if they focus on place as their primary focus, with the recognition of the uniqueness of each place in relation to their population, geography, and history of partnership working.

Local areas will be free to develop their own place-based partnerships, between the NHS, local government and health and care services, building on existing arrangements where they are working and with NHS England and ‘other bodies’ to provide support and guidance. Health and wellbeing boards (HWBs) will continue to have a place level leadership role in driving partnerships, and producing joint strategic needs assessments and joint health and wellbeing strategy, to which ICSs will be required to have regard. HWBs and ICSs will be supported to work together to complement each other. ICSs will be required to work closely with HWBs and have regard to the joint strategic needs assessments and the joint health and wellbeing strategies within their system. 

LGA view

We strongly support the emphasis on place and the need for flexibility and freedom for local areas to develop their own place-based partnerships and to build on existing health and wellbeing boards and local delivery partnerships. We are keen to provide coordination information and a support offer with DHSC and NHSE for system and place leaders to develop a shared understanding of the role of place in driving forward collaboration to improve health and wellbeing.

Other proposals on how to facilitate collaboration within the NHS

In addition to ICSs, there are several other proposals to facilitate greater collaboration between NHS organisations. These are summarised below.

  • A power for NHS England to set a capital spending limit for NHS Foundation Trusts, removing their financial freedom to borrow from commercial lenders and spend surpluses on capital projects. This will contribute to a new capital regime in which ICSs are allocated a system-wide capital spending limit. 
  • Proposals will also be brought forward to enable NHS providers and ICSs to form joint committees, which is a barrier to joint working and to allow NHS providers to from their own joint committees. 
  • Collaborative commissioning – There are a range of proposals to allow NHS England and ICSs to work together in different ways to commission services, similar to Section 75 arrangements, which enable local authorities and CCGs to exercise joint commissioning, lead commissioning and pooled budget arrangements.
  • Joint appointments – New provisions will allow NHS bodies to make joint appointments with other NHS bodies and with local authorities to drive joint decision-making, deliver integrated care, and engender a culture of collective responsibility across organisations.
  • Data sharing - There are proposals to ensure data sharing across health and care, including a requirement to share anonymised information to the benefit of the health and care system. There will be new powers for the Secretary of State for Health and Social Care to require data from all registered social care providers about all services they provide, and require data from private healthcare providers and to mandate standards for data collections and storage.  
  • Patient Choice – The aim of these proposals is to strengthen patient choice and control.  A key proposal is to repeal section 75 of the Health and Social Care Act 2012 including the Procurement, Patient Choice and Competition Regulations 2013 to replace with a new provider selection regime, which requires bodies that arrange NHS services to protect, promote and facilitate patient choice. 
LGA view

These proposals remove some of major barriers to greater collaboration between NHS organisations and as such we support them. In particular, we support measures that will improve data sharing between the NHS and local government and other partners at local level.  We will be keen to ensure that any new data requirements or standards do not add to the reporting burden for social care without providing a proportionate benefit, that the sector is involved in their design and, where possible, that suppliers of systems are required or encouraged to adapt their systems centrally to new standards and outputs. Any new burdens on local authorities associated with the implementation of new standards needs to fully funded.

Reducing bureaucracy  

Most of the proposals in this section of the white paper are concerned with reducing bureaucracy and streamlining processes to enable joined up working within the NHS. For this reason, they are not summarised in detail in this briefing. In brief, they relate to competition with the NHS, arrangements for commissioning and providing healthcare services, adapting the national tariff so that it is not barrier to collaboration between NHS organisations, the creation of new trusts by the Secretary of State for Health and Social Care and removing the requirement for Local Education and Training Boards.

We believe that councils will need to revisit their existing procurement and commissioning governance processes to take into account the additional new process and any future reporting requirements.

The LGA will keep a watching brief on developments with regard to reducing NHS bureaucracy to assess whether they have any significance for local authorities. NHSE has published a consultation on NHS procurement.

LGA view

We support proposals which reduce unnecessary and cumbersome requirements on commissioners and providers of NHS services.  However, we are keen that, as far as possible, the NHS and local government commissioning and financial frameworks are aligned. The DHSC will need to ensure that any measures to reduce requirements on the NHS do not, inadvertently, create barriers to the NHS and local government partners working collaboratively. We believe that councils will need to revisit their existing procurement and commissioning governance processes to take into account the additional new process and any future reporting requirements.



Regarding the power of the Secretary of State to create new trusts, we will seek assurances from DHSC that the existing powers of local authorities are not undermined or bypassed by this new provision. DHSC will need to consider what impact this will have on the powers and duties of the NHS and local authorities in relation to the reconfiguration of NHS services. Currently, the NHS has a duty consult any local authorities that are affected by any substantial variations or reconfigurations of health services. 

Enhancing public confidence and accountability

This section of the white paper is primarily focused on the NHS accountability arrangements. It includes proposals to:

  • formally bring together NHS England (NHSE) and NHS Improvement into a single legal organisation
  • give the Secretary of State for Health and Social Care intervention powers in relation to NHSE, in order to increase NHSE’s accountability to Parliament, and measures to strengthen and clarify the role of government and Parliament in respect of healthcare, public health and social care
  • make it easier for the Secretary of State to use the NHS mandate to set more flexible objectives for NHSE
  • allow the Secretary of State to intervene in local services configuration proposals ‘where required’
  • a power for the Secretary of State to transfer the functions of the NHS arms-length bodies with safeguards of scrutiny if the power is used.
LGA view

With regard to powers of the Secretary of State to intervene in NHS reconfigurations, we are concerned that this may undermine the existing powers and duties of local authorities on local NHS reconfigurations. We will seek assurances from the DHSC that the existing powers and duties of local government are not undermined or by-passed.



These proposals, taken together, greatly increase the power of the Secretary of State for Health and Social Care. While we appreciate the Government and Parliament’s desire for greater accountability of the NHS, we are concerned that no consideration is given to increasing local accountability of the NHS. We will be seeking assurances from Government that any new powers will not undermine local democratic accountability mechanisms.

Additional proposals: support social care, public health and quality and safety

The White Paper includes a whole raft of proposals, some of which are of major significance to local government and have not been the subject of public engagement or consultation. The document emphasises that the additional proposals, particular in relation to adult social care and public health, do not form a coherent package. They are intended to address specific issues highlighted during the pandemic, and which require primary legislation.

Adult social care

The legislative measures for social care in the Bill (as described below) are just one element of a wider programme of positive reform for the adult social care sector. Elsewhere, the white paper also notes the Government’s recognition of the significant pressures faced by the social care sector and states that the Government remains committed to reform.

LGA view

Adult social care has demonstrated its value throughout the pandemic; care and support is now in the public, media and political spotlight like never before. Recognition of the pressures facing social care, and a restated commitment to reform, are welcome. But the proposals do not address the urgent need to put social care on a sustainable, long-term financial footing to ensure social care can best support people to live the lives they want to lead. The LGA will work with the Government to ensure that local government is fully engagement in the further development of these proposals.

Data collection

The white paper proposes to improve the quality and availability of data across health and social care to remedy gaps in data to help understand capacity and risk in the system. The white paper also highlights the gap in data on services provided to people who fund their own care, as well as data that would help show how money flows to providers and the workforce. The white paper sets out how more and better data will aid planning for the future care of the population.

LGA view

We support the intention of gathering high quality data so long as the data collection is proportionate, the data sharing is purposeful, and its prime purpose is seen as supporting effective local commissioning and delivery of care. The data should be jointly owned by the sector, and should flow not just to the DHSC but also back to authorities, for them to understand and support their residents better, understand the impact of different interventions and support and be able to benchmark their own performance. To this end, local government should be involved in discussions to agree what data is collected and how. Where the DHSC collects data directly from providers this should be shared with local government in support of councils’ market shaping duties.

Assurance

The Government announced its intention to work with councils and the social care sector to enhance existing assurance frameworks that support the drive to improve the outcomes and experiences of people and their families in accessing high quality care and support. In support of this intention, the Government will introduce a new duty for the Care Quality Commission to assess councils’ delivery of their adult social care duties. Linked, the Government proposes to introduce a power for the Secretary of State to intervene where, following assessment under the new CQC duty, it is considered that a council is failing to meet its duties.

The white paper makes clear that these provisions will be secured in primary legislation at a high level, prior to working with the sector on detailed system design.

LGA view

We understand Government’s desire for greater transparency in social care. Councils need to be an equal partner in the design of any national oversight, which must build on existing sector led improvement work, recognise local democratic accountability and give a meaningful voice to people who draw on and work in social care.



Any new processes or structures for assurance and oversight need to be accompanied by a New Burdens assessment to fairly capture the capacity and resource implications for councils in meeting new regulatory approaches.



Any assurance process has the potential to highlight shortfalls in services and delivery of the intentions of the Care Act due to resource constraints. Any assessment of a council’s adult social care services would need to be contextualised in terms of available resources.



The assurance process must be developed in partnership with local government and the CQC; we would favour a review-driven approach looking at whole systems, based on a shared agreement of what good looks like – in particular, the importance of person-centred and locally flexible care and support.

Direct payment to local providers

The Government will legislate to amend the Health and Social Care Act 2008 to expand the powers of the Secretary of State so s/he can make direct payments of funding to any bodies engaged in the provision of social care services. Currently, the Secretary of State can only make such direct payments to not-for-profit bodies. This power will act as a legal foundation for future proposals and the Bill will not prescribe in what circumstances the power can be used or how it should be provided. The white paper is clear that the power will not be used to amend or replace the existing system of funding adult social care and will only be used in exceptional circumstances.

LGA view

We recognise Government’s desire for a mechanism that gets funding to social care providers quickly. Local decision-making, local knowledge of the provider market, and local democratic accountability are important underpinnings of the system of social care funding and should not be bypassed; it is therefore helpful that the white paper makes clear this power will only be used in exceptional circumstances.



We would welcome discussions with the DHSC to consider how best to ensure the use of this power does not disrupt the important local foundations of social care funding described above.

Discharge to assess

The White Paper updates the approach to hospital discharge by changing the legislative framework to enable a ‘discharge to assess’ model. This model includes enabling assessment for NHS continuing healthcare (CHC) and NHS Funded Nursing Care (FNC) assessments, and Care Act assessments, to take place after an individual has been discharged from acute care. To enact this model, the government plans to repeal existing requirements to assess for care needs before hospital discharge, and the accompanying process of assessment and discharge notices.

LGA view

We strongly support the ‘discharge to assess’ model, and its underpinning philosophy of ‘Home First’, which advocates that home is the most appropriate place for resolving crises and recovery for nearly all people being discharged from hospital.



We support the removal of the requirement for assessment and discharge notices. We note the white paper’s intention to put in place a legal framework to enable the ‘discharge to assess’ model. We hope this does not mean the creation of new legal duties; this is unnecessary and would duplicate existing duties in the Care Act to provide people’s care, and for the NHS and councils to collaborate in doing so.



We welcome the white paper’s ambition to ensure that these changes will not increase the financial burden on local authorities. We highlight also that continued investment in community healthcare is essential to ensure that the demands on social care, and therefore the financial burden, do not increase as more people are supported to leave hospital more quickly and recover at home.

Better Care Fund

The White Paper proposes to create a standalone legal basis for the Better Care Fund (BCF), separating it from the NHS Mandate setting process, which will no longer be on an annual basis.

LGA view

The LGA supports the proposal to separate BCF planning from the NHS Mandate. We hope this will enable future BCF planning cycles to be undertaken in good time, ahead of local government and NHS budget setting cycles. It will be key also to ensure that the new standalone power accurately replicates existing duties to plan and deliver the BCF jointly. Further, we welcome the indication in the white paper that the BCF will be a key component of place-based partnerships within the overall ICS architecture, and would encourage government considering how the BCF’s role within ICS planning can be enshrined.

Public health

The proposals relating to public health functions are summarised below.

Public health power of direction

The Government will bring forward measures to make it easier for the Secretary of State to direct NHS England to take on specific public health functions. Under section 7A of the 2006 NHS Act, the Secretary of State for Health and Social Care can make arrangements for his public health functions to be exercised by NHS England, however the Secretary of State cannot require NHS England to take the delegated function.

LGA view

It is unclear whether the changes relate only to public health functions exercised by NHS England or equally to public health functions exercised by local government. Any new legislation needs to be clear on which requirements apply to which parts of the public health system. The LGA will be seeking clarity on the Secretary of State’s power of direction.

Obesity

The Government plans to allow ministers to introduce new strengthened food labelling requirements, including changes to front-of-pack nutrition labelling and mandatory alcohol calorie labelling. The government will introduce further restrictions to prohibit advertisements for products high in fat, sugar or salt being shown on TV before 9pm.    

LGA view

We support proposals to strengthen front-of-pack nutrition labelling and calorie labelling on alcohol. We believe a single, standard and consistent system will help people make informed choices.



We also welcome plans to prohibit advertisements of products high in fat, sugar or salt being shown on TV before 9pm. It is disappointing that the white paper did not include plans to give councils powers to ban junk food advertising near schools, which is something that councils and the LGA have campaigned for.  

Water fluoridation

The Government plans to streamline the process for the introduction, variation and termination of water fluoridation schemes in England by transferring the responsibilities for doing so, including consultation responsibilities, from local authorities to the Secretary of State for Health and Social Care.

LGA view

Whilst we welcome the shift to a more streamlined consultation process for water fluoridation schemes, water fluoridation must not be imposed on communities.



It has been the long-standing policy that local decision-makers are best placed to take into account locally-expressed views and to balance the perceived benefits of fluoridation with the ethical arguments and any evidence of risks to health. Local authorities have encountered difficulties with the current consultation process, including the fact that local authority boundaries are not coterminous with water flows, which requires the involvement of several authorities in these schemes.

Delivering for patients, citizens and local populations – support implementation and innovation

This section starts by acknowledging the limits of legislation in driving change and sets out other measures to improve collaboration and effectiveness of health and care. These include workforce capacity, effective leadership, clear guidance and support and getting the right incentives and financial flows. 

It also outlines forthcoming reforms across the NHS, public health and social care that are part of the wider DHSC strategy but not part of the legislation outlined in the white paper. In particular it highlights the Government’s commitment to social care reform to enable affordable, high quality, sustainable and joined up care and support that meets people’s needs. It restates the commitment to bring forward proposals later this year. It also gives a commitment to publishing proposals for the future design of the public health system. The document also refers to the White Paper on Reforming the Mental Health Act, published in January 2020, as a key part of the wider policy framework for the NHS, social care and public health. 

The Government plans to introduce a Health and Social Care Bill to Parliament in 2021 so that the measures can start to be implemented in 2022. The document gives a commitment to continue engage with stakeholders on the detail of the proposals and to work across government to address the interdependencies between health and other social determinants.

LGA view

We have welcomed the degree to which the Government has engaged the LGA in shaping these proposals, especially in relation to the role and contribution of local government to integration and addressing the wider determinants of health.  Direct engagement with local government has been more inconsistent and we are committed to working with them and with NHSE to support leaders in local government and the NHS to understand and implement these reforms. However, some of the proposals, in particular in relation to public health and adult social care, have not been subject to public consultation or engagement. We urge the Government to commit to working with local government on every aspect of the white paper and subsequent legislation, and to hold an inclusive consultation and engagement on any proposals that have not previously been in the public domain.